The biggest risk factor for cancer is easy to recognize; it is written on your ID card. In the constant alternation between cell death, cell division and cell renewal, the organism makes mistakes and sloppiness around the clock. However, at a younger age, the reading errors in the genetic material are usually repaired efficiently and without any health consequences. However, as we get older, the body’s own workshop no longer works as thoroughly. Mutations and other cell changes happen, and if the damage does not lead to the cell’s rapid demise, proliferative, degenerated tissue can develop and cancer can arise. This is why most types of tumors become more common as people enter their last third of life. Every year the likelihood of getting sick increases a little.
The finding that an international team of researchers recently published in the specialist magazine is all the more surprising BMJ Oncology published. The frequency of cancer in younger people increased by 79.1 percent worldwide between 1990 and 2019. In medicine, cancer in younger people is broadly defined as extending into midlife and means that the tumors appear before the age of 50. The good news right away: While cancer has become significantly more common in this age group over the past 30 years, the increase in associated deaths has not been as massive at 27.7 percent.
Breast, lung, stomach and colon cancer contributed particularly strongly to the increase in the age group examined, although there are large regional differences in frequency. The most rapid increase in the past three decades has been in tumors of the pharynx and prostate; Liver cancer, however, was observed less frequently. Since cancer becomes more common with age, even in younger and middle-aged people, it is not surprising that the 40- to 49-year-old group was most affected by the increase in tumors. In addition, there was a particular increase in middle- and high-income countries, so the researchers identified the popularity and further spread of the Western lifestyle as the main cause of the increased cancer cases – unhealthy diet, obesity and a sedentary lifestyle.
The authors blame the consumption of alcohol and tobacco for many cases of cancer
“A healthier lifestyle could help significantly reduce cancer cases in younger people,” say the authors. They blame alcohol and tobacco consumption, which is still popular in many places around the world, for the increased incidence of tumors in this age group. In addition, a diet with a lot of red meat, a lot of salt, a lot of sugar, heavily processed products and at the same time little fruit, milk and vegetables as well as a lack of exercise contribute to earlier onset of cancer.
The fact that the four tumor types breast cancer, lung cancer, stomach cancer and colon cancer contribute to the most deaths and years of illness in the age group under 50 stands in contrast to the typical picture of cancer in younger people, write Ashleigh Hamilton and Helen Coleman from Queen’s University in Belfast in one Comment. “The epidemiological distribution of cancer incidence is changing.” There is a risk of a significant wave of illness and additional strain on health systems worldwide, as the unhealthy Western lifestyle is spreading with increasing prosperity, especially in many former emerging countries. Cancer also usually has different socioeconomic consequences for 45-year-olds than for 75-year-olds: Younger people at this age are often still raising children and are in the middle of their working lives.
Data from 204 countries and 29 different types of cancer were included in the evaluation of cancer frequency around the globe. Although such comprehensive analyzes provide a good overview of the disease burden and global trends in tumor spread, they cannot capture the specific characteristics of each type of cancer. Hamilton and Coleman demand that the proportion of congenital cancers needs to be better quantified. Such rare hereditary syndromes are known for many tumors; However, it is uncertain whether they will also become more common worldwide.
The call for better programs for early detection and prevention is often correct in medicine. However, the discussion about lowering the age for mammography screening from 50 to 45 in Germany shows how complex the problem is. If women are screened for breast cancer as early as 45, only a few additional tumor cases can be discovered because this cancer – despite the worldwide increase – occurs less frequently in this age group. At the same time, however, more false alarms and overdiagnoses will occur in women between 45 and 50 because their breast tissue is even firmer and therefore harmless densities can be mistaken for cancer – or tumors can be overlooked. The inaccuracy of diagnostics is increasing.
In addition, the large difference between an increase in cancer frequency of 79.1 percent in the age group under 50 and a simultaneous increase in the death rate of “only” 27.7 percent does not only indicate better treatment options and chances of recovery for many types of cancer. At the same time, the problem of overdiagnosis could also be hidden behind these numbers. Typical “age-related tumors”, which occur at a younger age, are usually considered more aggressive and dangerous. However, thanks to ever-improving examination methods, tumors are now being discovered that grow so slowly and are therefore comparatively harmless that the diagnosis causes concern for patients, even though they would not have any symptoms for a long time or perhaps never.